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US doctor forgives $650k in medical bills for cancer patients

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Re: US doctor forgives $650k in medical bills for cancer patients

#291

Post by erentz »

Areading314 wrote: post #11

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also…

So I currently have over $480,000 in denied claims. (I am fairly hopeful it will be resolved shortly, thanks to a complex work around my employer organized since it’s a self funded plan.)

I made sure that the treatment was preauthorized. Got a copy of the preauthorization. And I have a recording and email of the insurance company confirming the providers are all in network. But they denied the claims for being out of network anyway.

The part of the insurance network that provides the authorization is Blue Shield of CA. Even though I live in WA the authorization gets sent to Blue Shield CA. And that’s how they want it done. They approve it. They somehow look up and say provider is in network (multiple times). The provider themselves confirms all this too calling them. Then after treatment, when the claims are submitted, Blue Shield CA denies as out of network and tells the provider to submit to the Blue Shield franchise in WA (Regence). Now somehow the provider (an infusion pharmacy) isn’t in network with Regence, they are with Blue Shield CA. And so clearly in the Blue Shield nationwide network but not specifically with Regence. So Regence also denies it as out of network. Then they tell me this is somehow all correct and it’s my problem.

There is literally NO WAY for anyone to avoid this kind of trap. I was told they were in network multiple times, and they explicitly authorized the treatment knowing full well my home address and home state.

PS: the $480,000 is the magical inflated pricing, in real pricing ends up being <$100,000.

Re: US doctor forgives $650k in medical bills for cancer patients

#292

Post by arcticbull »

cmrdporcupine wrote: post #234
arcticbull wrote: post #23

Earlier quoted context omitted.

> It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) Not in a single-payer state, no. It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper an…

I like our healthcare system here in Canada, but this is not fully true. There are often experimental or very expensive treatments that the provincial health care systems don't cover, and so every few months I hear about some medication for a rare disease or cancer that someone is struggling/lobbying to get covered. One historical example is Herceptin, for treating breast cancer. It took six years to get the Ontario…

> In general, in Canada, medical care is covered but prescription pharmaceuticals are not. Which needs to be remedied.

Dental and vision too!

Re: US doctor forgives $650k in medical bills for cancer patients

#293

Post by arcticbull »

inter_netuser wrote: post #287
arcticbull wrote: post #285

Earlier quoted context omitted.

Btw the majority of those who “left for healthcare” are the Canadian old folks who spend half the year in America and have insurance as a result.

source? I know dozens that went to the US for treatments. Some even took out second mortgages because it was a choice between languishing on a waiting list with a heart condition that can kill you, or getting it fixed next week.

I suspect their new insolvency created a different kind of heart condition.

One way of deriving this is the cost of an average hip replacement in the US is $100,000 USD ($128K CAD) - how many Canadians have a spare house kicking around to finance a hip? Probably not that many.

Further, this paper, [1] and this write-up [2].

If you actually read the policy brief on which your article was based [3] you'll find a few interesting things. For one, they acknowledge that this travel includes traveling for non-covered procedures like cosmetic plastic surgery. It also implies snowbirds are not covered in this data, but then acknowledges in the next line that they probably are too but they don't have actual breakdowns other than their own "knowledge" that people are leaving due to wait times.

"The federal agency wasn’t able to provide a breakdown of patients seeking medically-necessary procedures and those leaving Canada for cosmetic surgery." This feels like important information to know.

I find this paper incomplete and un-compelling.

With that said I did find this statement in the second street brief pretty funny: "While health care debate in Canada often focuses on comparing our current system with the United States, readers should note that the Commonwealth Fund report ranked the United States 11th out of the 11 countries it examined."

[1] https://www.healthaffairs.org/doi/10.1377/hlthaff.21.3.19

[2] https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...

[3] https://www.secondstreet.org/wp-content/uploads/2019/04/Poli...

Re: US doctor forgives $650k in medical bills for cancer patients

#294

Post by lotsofpulp »

alistairSH wrote: post #260
lotsofpulp wrote: post #237

Earlier quoted context omitted.

>You keep saying "erroneously" but I'm not sure what you mean by that. "Erroneously" as in denying coverage for something that should be covered (per the terms of the contracts). It's unfortunate that you have to go through all of that when changing medications. I don't know the reason for it in your specific case, but I would hope it's not widespread fraud across all of those companies.

Sure, I won't go as far as calling it outright fraud. But, it certainly is part of the business. And as the consumer, at the time of service, I really don't care why it happens, only that it does and that it costs me time and money and delays treatment. As far as I can tell, it's a byproduct of an adversarial relationship between the 3 parties (consumer, doctor, insurer). Insurance doesn't trust the MD to do his job,…

>the insurance company's own MDs are only there to provide legitimacy to the initial denial.

I have first hand knowledge that this is false. Especially if the insurer is just acting as an administrator for a state Medicaid or federal Medicare or other payer, since there are big penalties for denying coverage just to save money. The insurers even have MDs and PharmDs to audit their own MDs and PharmDs to see if they are appropriately approving or denying treatment.

A lot of the problem is probably coming from lack of proper EMR and supporting documentation justifying treatment, and subjectivity in justifying treatment because there are many gray areas.

This same approval denial situation happens under taxpayer funded healthcare also, since no one has unlimited resources. But yes, the US implementation of it with myriad payers and rules certainly makes for an unpleasant experience and results in subpar healthcare.

Re: US doctor forgives $650k in medical bills for cancer patients

#295

Post by hn2fast »

pulse7 wrote: post #204

It is shocking that this is news! This should be normal and expected behavior and not news!

No, this should never have to happen. Medical professionals are certainly well-compensated, but direct providers of care receive less than 15% of healthcare revenues. It shouldn't be expected for doctors to personally pay off medical debts, they shouldn't exist in the first place!

Re: US doctor forgives $650k in medical bills for cancer patients

#296

Post by ashtonkem »

programmertote wrote: post #268
trynewideas wrote: post #162

Some context: the clinic (technically named the Arkansas Cancer Institute, not the Arkansas Cancer Clinic as in the story) faced lawsuits in 2018-19 after more than 50 patients tested positive for an undisclosed bacterial infection linked to saline flushes on infusion ports.[1][2] The results of the lawsuit weren't reported, but the clinic closed in February 2020, about a year after the firm behind the suit pursued c…

Glad to see someone pointing out the context. Certainly this doctor and his family did a great thing by forgoing the debt owed by his patients. BUT, my wife worked and volunteered at a few private clinics around NY metro areas and I would wager that this doctor's clinic already makes a lot of money (2-3x that 650K) every year if not more. As an example, one of the primary care physician's clinic that my wife (who is…

One of the most pernicious things that’s cropped up within my lifetime is the idea that lost revenue is a justification for something else. A lot of low level (per incident, not aggregate) fraud and malfeasance gets justified this way.

Re: US doctor forgives $650k in medical bills for cancer patients

#297

Post by ashtonkem »

atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

Voters typically like the idea of universal coverage, and strongly dislike the idea of being forced to give up their health insurance. The idea of banning private insurance is deeply underwater.

This is one reason why some advocate for a strong public option; if it’s seen as superior to the private choices it would either win out (resulting in de facto single payer), or drive down the cost of private insurance until it’s price competitive with the public option.

Re: US doctor forgives $650k in medical bills for cancer patients

#298

Post by lotsofpulp »

bcrosby95 wrote: post #243
lotsofpulp wrote: post #137

Earlier quoted context omitted.

> We don't get this nonsense where the insurer tries to deny us and hope that we don't dispute. It’s also not the case in 99% of US claims. The ones you hear about are typically due to healthcare providers not providing sufficient justification for the healthcare or medications they are prescribing, which can easily cost tens of thousands, if not hundreds of thousands of dollars. The “insurers” are many times not eve…

When my wife had surgery and insurance denied part of our claim, hospital billing said it was normal, and it usually doesn't get resolved until one of their lawyers sends a strongly worded letter.

Is it possible the hospital also has a tendency to over charge? For example, the data for Synagis indicates it only works to prevent RSV in a very narrow set of cases. It's a very expensive medicine. And it's vastly over prescribed based on the efficacy data, so a parent who is already emotional over their premature baby is going to be frustrated if/when the insurance company denies it. The doctor isn't going to into detail and explain that the data doesn't support its use. They're incentivized to "do something", even if it's a shot in the dark.

Re: US doctor forgives $650k in medical bills for cancer patients

#299

Post by lancepioch »

duckfang wrote: post #265
baldeagle wrote: post #245

The really messed up thing about this is the tax implications. The doctor gets a write off for his 'losses'; his tax bill it lower. The patients are subject to paying tax on this as-if it were income (because they received $X of debt cancellation). Their tax bills will go up.

So, can I go around writing "Debt forgiveness bills", take that off my taxes, and report them as "debt reconciliation income"? What allows them to make up magic numbers for a price?

Tax fraud is a felony. If morality doesn't stop a person from doing what's wrong, then usually the law (and its repercussions) does.

Re: US doctor forgives $650k in medical bills for cancer patients

#300

Post by lotsofpulp »

francisofascii wrote: post #226
alphabettsy wrote: post #28

Earlier quoted context omitted.

It’s intentional. They save billions using this practice because some people don’t have the time, knowledge or resources to dispute.

Exactly. Dealing with the back and forth between the insurance company and the provider today, actually. What a hassle. Only over $150 for charging me for an annual preventative care visit which should be covered by insurance. Normally I would just pay to avoid the hassle, but this I will try to fight it.

I've dealt with the same nonsense. Is this your first time with that specific doctor? The doctor has to use one of the annual wellness visit codes, so if it's your first time, the doctor will charge you a new patient charge code, which is higher reimbursement than a wellness visit code, so insurers will deny it.

However, I was able to tell my doctor's office that I want the wellness visit charge code only, and they did that. I don't even see a reason for the new patient visit code to exist, since they are allotted the same time and subject matter.

For example:

https://content.highmarkprc.com/Files/EducationManuals/Geria...

If a doctor bills for code 99387, that might not covered under "annual wellness visit" or "annual physical" by the insurer, so you end up having to pay the whole amount if you haven't met your deductible. If the doctor bills code 99397, then it would be.

But it shouldn't be this hard. The insurer should be forced to show the codes that qualify for the free annual wellness visit, and you should be able to inform the doctor's office that you want to purchase services for that code and that code only.

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